< Part
1 - Gluteal (Buttock) Implants > Each style and size of butt
implants has varying dimensions, and hence, different volumes. Again,
the selection of the proper style and size buttock implant depends on
the desired need, and "look" your surgeon feels is appropriate
to achieve the best, most natural appearance.

< Part
2 - Calf Implants > When it comes to calf implants and calf anatomy,
what are considered “good anatomical proportions?” And,
how is this determined?

Introduction
to Calf Augmentation—
Calf implants are typically used for reshaping the lower leg region—specifically
the anatomical proportions of the medial (inside) and lateral (outside)
Gastrocnemius and Soleus muscles (commonly called the calf)—to
the upper leg region (quadriceps or thigh).

There are two common surgical approaches
to calf augmentation. One involves placing the calf implant under the
deep fascia (submuscular technique, or under the aponeurosis);
the other procedure places the implant just under the dermis, within
the fascia of the muscle (subfascial technique). This report
will examine the two methods of calf augmentation, discuss the implant
construction and design, delve briefly into the surgical techniques
involved, and discuss the results and expectations from each method.

To begin, it’s important to understand
the basis, or rationale for calf augmentation. It’s performed
for both aesthetic and reconstructive reasons. From an
aesthetic perspective, both fashion and lifestyle changes in
Western Society have made calf augmentation more desirable, particularly
among women, because of an emphasis on shapely legs due to dress and
shoe fashions. Simply said, in modern western cultures it’s considered
a physical attribute to have attractive, well-defined legs. As well,
there is an increasing demand for calf implants among both male and
female athletes who desire additional definition in the calf area, which
can’t be achieved by only muscle mass increases.

In reconstructive applications,
calf augmentation is a vital and necessary method of rebuilding the
lower section of the leg due to congenital disability—particularly
in Poliomyelitis (Polio), which is a leading cause of calf deformity.
Other genetic disorders can affect calf development as well, including
Spina Bifida and Club Foot. In each case, an aesthetic and/or reconstructive
surgeon will evaluate the proportions of the calf in relation to the
overall anatomical ratio of the leg and musculature.

So, when it comes to calf implants and
calf anatomy, what are considered “good anatomical proportions?”
And, how is this determined?

The discussion of anatomical proportions
begins with an understanding that the science of aesthetics and interpretation
of beauty is one that varies demonstrably from one individual
to another. What may be considered “attractive” to one person
may not be considered so in another. Hence, aesthetic beauty is not
considered a cognitive function. That means, one doesn't “think”
about what makes a person beautiful/attractive to them—they only
“react” to physical characteristics. Because of this, the
interpretation of what one thinks is beautiful, or attractive, is thought
to be resident in the subconscious, or limbic cranial system. The term
Limbus, or Limbic, in medical terminology is used to describe a border
region. In the brain, it’s those structures including the hippocampus,
amygdala (amygdaloid body), dentate gyrus, cingulate gyrus, gyrus fornicatus,
the archicortex, septal area and others. This area of the brain is set
in motion by external influences (stimuli—such as seeing an attractive
man, or woman) creating either subliminal or self-aware motivational
behavior (desires/wants/arousal)—which in turn affects the endocrine
glands and autonomic nervous system (sweat glands, heart rate, etc.).
A very simplistic example of this would be if you saw a visual representation
that you thought was attractive in some way . . . this information stimulates
a desire, which in turn initiates physical indicators such as making
your heart beat faster, or getting excited, etc. It’s a primal
region of the brain, and as such, seems to be the determining force
behind one’s desires for a particular type of man, or woman.

Is beauty an attribute really in the eye
of the beholder? Most definitely . . . yes.

That’s because there are so many
different interpretations of beauty. As well, there are also some defined
similarities. These commonalities in aesthetic beauty were first studied
centuries ago by a number of people . . . most often those involved
with architectural or artistic occupations. Their goal was to determine
what good human proportions actually were, from those who were thought
to be attractive by many people. It was largely done so they could reproduce
these appearances in artwork and designs; a matter of good business
practices, rather than biology or medicine. Only later did mathematicians,
engineers and medical scientists got involved in refining these views
and calculations. However, much of what was initially determined still
is used today.

As it relates to the lower leg, anatomical
proportions considered to be aesthetically pleasing were, of late, calculated
by Dr. R. M. Ricketts who determined these dimensions to be mathematical
ratios of X, Y, Z (width, height, depth), as well as angular proportions
of the human body, to define what is termed the “golden proportion”
(1:1.618). Ricketts was not the first determine this ratio, as it’s
been deeded to an Italian mathematician, Filius Bonacci, who first recorded
this information back in the 12th century. For calves, the most aesthetically
pleasing dimension, or proportion, is merely a matter of measurement.
In simple terms, if one measures the distance from the knee to the widest
medial point of the calf muscle, then multiples this distance by 1.6,
the proper proportions as stated by the golden proportion ratio, the
entire length of the gastrocnemius muscle (calf muscle) must be at least
1.6 times the length of this upper value, to create proper calf symmetry.
Circumference varies, according to length of entire muscle, but generally
it has been found to be approximately 12-13 inches in size for most
women.

Where
Calf Implants Are Inserted—
Once a need for calf implants is determined, they are placed either;
1) subfascially, or; 2) submuscularly—underneath the aponeurosis
(subaponeurotically)—flat fibrous sheets of connective tissue
that typically attach the muscles that make up the calf—gastrocnemius
and soleus muscles—to the bone. More commonly, calf implants are
placed subfascially (just below the fascial plane), but many of the
best results are obtained by placing the implant in the submuscular
plane—deeply within the muscle.

1. Subfascial placement of the calf implant
is generally performed more often because the procedure is less dissection-intensive,
less difficult, and results in generally faster recovery times with
patients reporting less pain. However, subfascial implant placement
can sometimes result in calf implant movement (drift or rotation), and/or
result in the patient being able to feel the perimeter edges of the
implant afterwards, because they are usually harder than the nearby
muscle and not enough tissue covers the implant itself. As well, sometimes
the desired effect isn't aesthetically as pleasing as the submuscular
method because the implant itself tends to define the final shape of
the calf region, rather than the muscle tissue. This is true with either
silicone-gel or solid silicone calf implants. Subfascial implantation
also requires more attention to the placement of the implant, which
can become difficult when trying to reach the most distal region (distant
from the center) of the crural pocket where the implant is placed.

2. Submuscular (subaponeurotically) placement
is considered a more difficult procedure and requires more surgical
skill as the operation delves deeply into tissues. Generally, however,
the results are better because the implant is placed more securely and
accurately within the gastrocnemius and soleus muscles (within deeper
fascia tissues), allowing for more aesthetic placement of the implant.
Also, it’s been observed that submuscular implantation can result
in a more natural calf shape and feel because the actual muscles of
the calf cover the implant completely. However, this method of calf
augmentation generally requires a few more days of patient recovery
time and more discomfort until the deep tissue trauma begins to heal.
Another benefit of submuscular placement is that since this procedure
is more involved it also allows for greater control of potential surgical
hazards including vascular or nerve damage—incisions are made
far away from the junction of the gastrocnemius muscles.

In both methods, however, basic anatomy
is favorable for calf augmentation because there are few nerves or blood
vessels present in this area, hence little chance of permanent damage.
Once the surgeon locates the key sensory nerve (tibial nerve) they can
proceed without too much concern, forming the desired implant pockets
in the muscle compartments.

Calf Implant
Materials & Types—
Both silicone-gel implants and solid silicone implants are available
for calf implants. Silicone-gel calf implants sometimes have problems
with capsular contracture, although this is much more problematic with
breast implants rather than calf implants, while solid silicone implants
can leave an edge that can be felt externally if placed too near the
surface, as with subfascial calf augmentation.

Silicone-gel filled calf implants usually
come in symmetrical a cigar-shaped size with volume ranges from 50-220cc.
Many are also available in anatomical sizes (asymmetrical), where the
upper portion of the implant is usually larger in volume than the lower
section. Most silicone-gel implants have a shell that is composed of
silicone elastomers (medically approved grade), and a volumetric gel
that is made of cohesive silicone, so it won’t migrate to other
areas if the implant is somehow ruptured. Solid-silicone implants, and
middle-soft silicone implants come in a variety of styles and because
of their solid and semi-solid consistency the surgeon can carve them
into custom shapes before implanting to allow for asymmetric muscular
development. Anatomical implants (asymmetrical), are best used for body
builders who desire a more dramatic look for enhancement of the medial
(inside calf) point, or peak. This added volume can give the body builder
the “cut” they desire when they can’t achieve additional
mass by weight training alone. Normally, most consumers are fitted with
symmetrical calf implants because the narrower profile permits a more
natural curve in proportion to the upper thigh. Sometimes, depending
on the size of the patient’s ankle, circumferential liposuction
will also be performed at the close of the procedure to sculpt the areas
above the ankles and subcutaneously above the calf muscles to enhance
the overall look of the leg.

Aesthetic & Reconstructive Technologies, Inc. (AART), a highly respected,
well-known manufacturer of implant technology offers surgeons only the
best, most advanced implants for use in their surgical procedures. All
of AART’s implants are manufactured out of the highest quality
Implant Grade silicones and are engineered to mimic the tissues that
they are augmenting or replacing.

As you might expect, all calf implants
are sterilized before placement. Each Style and size of calf implant
has varying dimensions, and hence, different volumes. Again, the selection
of the proper style and size calf implant depends on the desired need,
and "look" your surgeon feels is appropriate to achieve the
best, most natural appearance.

Custom calf implants, made of solid silicone,
can be carved specifically for the individual. Some surgeons, usually
those with vast experience in the implant procedure, can modify them
as needed with surgical instruments such as a scalpel or scissors before
placing them within the muscle plane.

Calf Implants are available in three styles
and several sizes. They are available non-sterile and sterile, and are
packaged and sold individually. Depending on the patient needs, the
doctor may use one or two implants (medial and lateral) in each leg.

Calf
Implants—Style 1

Size

1

2

3

4

5

Width

6.1

6.8

7.8

9.4

12.2

Length

12.6

13.7

14.0

16.2

16.5

Volume (cc)

50

65

90

125

220

Calf
Implants—Style 2

Size

1

2

Width

6.1

6.5

Length

17.2

20.3

Volume (cc)

85

120

Results &
Expectations—
In almost every case, with either method (submuscular or subfascial)
of calf augmentation, patients were able to return to normal activities
within a few weeks. Body builders sometimes required slightly more time.
As well, calf augmentation reports one of the highest levels of satisfaction
among patients, with less than four percent (4%) reporting any complications
or infection. Some surgeons report even being able to eliminate antibiotic
regimes by applying some techniques from breast augmentation, including
the use of barrier membranes to prevent contact between the implant
and skin. It has also been determined that calf implants and augmentation
does not in any way impair the normal function of the calf muscle or
calf, and in fact, offers a level of improved self-esteem in those who
have had the surgery performed.